Play is at the heart of this nurse's career with hospitalized children

By Louise Kinross

Irene Simpson (photo right) recalls tiptoeing into rooms at Bloorview Children’s Hospital to place stockings at the foot of children’s beds on Christmas Eve in the 1990s. “There was one patient who believed in Santa and every time I went in, he was wide awake," she says. "I had to tell him: ‘Santa won’t come if you don’t go to sleep.’ We used to go out and buy tons of gifts for everyone because they weren’t going home, and families didn’t bring gifts in.”

Irene began work as a frontline nurse at Holland Bloorview 30 years ago. This July she retires from her role as clinical operations manager for our complex continuing care unit, respiratory therapy, and Get Up and Go pain program.

The biggest change she’s seen is in “how we partner with families,” Irene says. “When I first started, we gave families the opportunity to leave. We said ‘It’s okay, we’ll take care of your child. We’ll do the complicated stuff.’” That meant parents often didn’t have the skills to use ventilators and other medical equipment, and children lived in hospital.

“Now we say: ‘How can we help you to do the complicated stuff? We want them to feel comfortable and confident that they have the skills to care for their child and take them home.”

Irene’s mother was a nurse and midwife and Irene got interested in nursing as a teen when her mother and brother spent time in hospital. Later, while in nursing school, her mother was hospitalized after a kidney transplant. “I went in every day after school and practised everything I was learning,” Irene says.

Irene’s first clinical placement was at SickKids Hospital. “I loved it. I was a brand, new nursing student doing nothing but baths on the oncology unit. One boy would come in and put a sign in his window that said: “Back by popular demand.” He was such a fun kid. He was teaching all the kids on the unit how to run down the hall and jump on their IV pole and keep cruising.”

That playfulness is something Irene enjoys most about working with children. “Being silly when you’re in a role like a nurse helps kids open up and relax,” she says. “They become engaged in what you’re doing. I still remember a patient from many years ago who liked having water pistol fights.”

The youngest patient Irene cared for at Holland Bloorview was Emily Chan (above photo left), who was transferred from SickKids when she was 10 months old in 1997. Emily has a rare neuromuscular condition that causes general weakness and serious breathing problems. She uses a ventilator and spent six years living at our Bloorview site.

“My favourite memory with Irene was when I would run to her office excitedly anticipating what colour paperclip she would give me," Emily says. "I collected them and I was fascinated that they came in different colours.”

In a welcome twist, Emily now reports to Irene as a social worker, counselling families on the same unit she grew up on. “When you see a child who’s trached and vented, you’re not sure what they’re going to be able to do,” Irene says. “Emily is an example of the impact nursing can have on a child’s trajectory. I was so excited to hire someone with a very unique lived experience who is an amazing role model.”

As a clinical operations manager, Irene’s days are filled with meetings, huddles with staff to assess what’s happening on the unit, and work with educators to ensure nurses and other team members are trained to care for patients with complicated needs. “I don't think we're seeing many new diseases, but we’re seeing the impact the social determinants of health have on a family’s ability to manage and care for the child,” Irene says. “Maybe they don’t have a regular income. They don’t have stable housing. Their family is fractured. There are language barriers.”

With advances in genetic testing, “you have a parent, often the mom, who feels guilty that their child’s condition is somehow their fault, even though it’s obviously not anyone’s fault," Irene says. "The nursing role is not just about nursing care, but about how you support families going through so much emotionally.” Because nurses are with patients around the clock, they spend the most time with families. “Despite everything, sometimes it seems there is still the mentality of “Oh, you’re only the nurse.”

Irene’s frontline experience informs everything she does as a manager. “I have a better understanding of what the families are experiencing," she says. "I can review a diagnosis and go: ‘Okay, I know what that will look like.’ I better understand how to support our nurses when they’re working with a child with a complex diagnosis or family dynamic.”

If she could give herself advice on her first day, it would be: “Talk to everybody. There are so many people in this building that have so much knowledge, so much understanding, compassion and empathy. That really helps when you’re trying to understand families. When I began as a student, I didn’t really talk to anyone. I got given my assignment. People went off on their break and didn’t invite me, so I didn’t establish relationships. Finally a seasoned nurse took me under her arm and introduced me to everyone.”

To manage stress, Irene relies on work peers, friends and her two dogs. “I have one very laid back Beagle, and a Jack Russell Chihuahua who is not laid back. When I walk through the door they give me absolutely unconditional love." Irene loves travel, and a week after she retires in July she will board a cruise ship in New York. “It ends in Australia in September and we go to everything in between.”

If she could change something about children’s rehab, it’s the support families get in the community. “I’d like to see them have the nursing they need, at the rate they need, so we can discharge them home.” This is particularly important for preschool children whose parents don’t have school to break up the day. “They may only get eight hours of nursing a night but be responsible for their child’s medical care for 16 hours of the day, and possibly have other children to support."

Irene recalls that for the first six months she worked full-time at Bloorview she often felt inadequate. “I was doing 12-hour shifts opposite another nurse who had been here forever, and he was so skilled. I felt like a complete failure in comparison. I would come in after he was working and the kids were completely ready, all the documentation was done, and I had nothing to do. When he came in, I was still running around trying to empty suction bottles and do my documentation. I would drive to work every day telling myself ‘It’s okay, you can do this.'

“It wasn’t until the first Code Blue I had to participate in that I suddenly realized I knew what to do. After that I could relax and know everything was okay. I think that’s typical of so many nurses. You don’t realize how much you know until you’re in a position where you have to apply it.

"I love that I have continued to learn new things. Hopefully I’ve been able to encourage others that you don’t always know everything, but you can always ask, and continuously improve your practice."

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